NO PERMIT NUMBER W77 I 9&,,& Ae LOT NO. �3
NO, STREET
APPLICATII F MING PERMIT
W i ? I
o a Date 96L 9 �968PerlNo
LL /,
3U
Pee S �2 9. 5
° Application is hereby made4o the It o��'�/j}};�;��{,['�'rr-� ,apermit t0 install plumbing
'o w pipes and/or fixtures listed on here�rse sine hettf Rh�t3..Rgrees to install sid prics
I and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
LL Use of Premises T S-
00 �•-
> W //DD Box /40.S
O S
3 Owner. Address
0a
Z-1
z By
O CONTRACTOR, AGEN •�
3 a
Phond4- 0 p �(e 625 Charles Street
— � e__
w San Jose, California 95112
11 a o State License 171537 Approved "
LA=U PLUMBING INSPECTOR /
l" V
QFIXTURES NUMI3ER MAIN DRAIN
UNITSI FEES UNITS FEES
Water Heater Size
Water Closet -4/1-57D Material �•'
Bath Tub • SO To Curb
Shower 3,00 To Prop. Line
Lavatories To Existing
Kitchen Sink ,yam Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine .,)O Size
Water Softener Material
Bar Sink To Main
Comb.Sink&Tray To r
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Ilopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee so
Area Drain Main Drain Fee 06
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee 00
Total p Total Fee s!J